Medical Discussion of Coronavirus

[StarTrekDoc]

As with most things, I’d prefer to see the data first.

Pfizer did release this specifically just this week to prerelease site, but not yet peer reviewed; we do know that moderna did too with the earlier UK and SAfrican variants. It makes sense.

The question really is WHEN do we pivot to an updated hybrid vaccine, at what dosing, and at what frequency. These whack-a-mole questions remain outstanding.

More evidence coming that the answer is: soon, multivalent and probably every six months cadence. <--my best guess.

As for CURRENT guidance I'm giving to patients : shrug. don't know. You're safest at home. Mask with Vogmask when in doubt. Travel if you want. If you're at risk, would 'consider' checking current titers to help individual risk decisions. You 'may' consider another mRNA shot - but I cannot recommend this or not as currently no guidance. -- Full disclosure - if my at-risk parents' titers are low -- yeah, they're getting another Pfizer shot.

[Hatton]

I had no problem buying a box of 40 n95 masks (American made) from walmart. I have not boosted myself with a third shot. No time before I fly to Texas next week. I am hoping for some clarity on the booster decision soon.

[FIREshrink]

.

. You 'may' consider another mRNA shot - but I cannot recommend this or not as currently no guidance. -- Full disclosure - if my at-risk parents' titers are low -- yeah, they're getting another Pfizer shot.

There is some data, from Israel.

[StarTrekDoc]

There is some data, from Israel.

Very limited data. Small group. Subset hard to delineate. The follow on study even smaller numbers.

The Provincetown data will be interesting in transmissions and followup. Particularly interested in those who tested positive without symptoms and if transmissions happen there...along with viral loads on those folk and correlation to titers if available (unlikely)

[Rando]

Who would patients find more trustworthy?

I think someone like Ashish Jha has been pretty level headed through this whole thing.and as far as I know hasn't made a bunch of enemies. I don't know whether the CDC has somebody on its bench they could bring up. if your point is there will always be some people that won't accept anyone I agree.

[StarTrekDoc]

Who would patients find more trustworthy?

fauci has been tainted from the past missteps.

Chief of public health and epidemiology from Hopkins, mayo or Harvard come to mind. Designate them to review, agree on statements and them rotate on presenting information. That'll keep check and balances and common agreed talking points and policy thoughts that CDC can rely open and then make policy citing them. Relative KIS and arm's length of politics

[Sundance]

My vote is get rid of Fauci first. He’s become a total joke.

Then get a committee of 5-10 academic types from the name institutions. Keep every name anonymous if possible so these guys won’t be tainted by the political blowback from colleagues and the public.

Then see what consensus recs can come from them.

[Lordosis]

What was the point of the lockdown in the masking? It was to slow down the spread of the virus. This was initially done so we did not overwhelm the healthcare system. Then that mantra pivoted to stopping the spread until a vaccine was available. And then it was until everybody had a chance to get the vaccine. Now it is until people have better vaccines or more data on boosters.

We really do need an end game for this. We need a Target. something that is achievable. Not something stupid like 100% vaccination rates. But really at this point if you want to be vaccinated you can be. And if you're vaccinated even if you do get the variant it will likely be not very significant.

[CordMcNally]

While it’s all good that we can get a lot of people vaccinated in the US what good does it do with other countries not getting vaccinated and just a perpetual timeline of a new variant every 6 months? I agree about the end game. Currently there’s no end game.

[FIREshrink]

What was the point of the lockdown in the masking? It was to slow down the spread of the virus. This was initially done so we did not overwhelm the healthcare system. Then that mantra pivoted to stopping the spread until a vaccine was available. And then it was until everybody had a chance to get the vaccine. Now it is until people have better vaccines or more data on boosters.

We really do need an end game for this. We need a Target. something that is achievable. Not something stupid like 100% vaccination rates. But really at this point if you want to be vaccinated you can be. And if you're vaccinated even if you do get the variant it will likely be not very significant.

Unfortunately we did not write the rules, nature(?) wrote the rules; we're just playing the game.

No one's seriously talking lockdowns, so that is just being thrown around as a strawman. Yet even today regional health care systems are at capacity because of delta and because of behavioral choices their populations have made. Every indication things will worsen near term without intervention. Should anyone do anything about that?

Increasingly the vaccinated are fed up with unvaccinated adults, who've had their chance. Were it only them, i think society ready to move on. Unfortunately, the unvaccinated include kids 11 and under who haven't had their shot, so to speak, and in the context of a new variant with much higher viral load and intuitively more likely to cause severe illness even in younger or previously healthy (not yet established). School starting across the country. I see any attempts at societal mitigation as really driven by a desire to protect that group. Agree or disagree, but that's the last group in America who are unvaccinated not by choice. Rules prohibiting school mask mandates truly bewildering. Let's find every way possible to keep kids in school full time, that means limiting outbreaks/contagion and for a group that can't be vaccinated, masks an important part of a multi-prong mitigation strategy.

Finally, issue of boosters for elderly and immunocompromised, already settled in Israel, boosters approved. How long will we wait to do the same? Once that happens (ie I'm betting it will) then again, a few months and everyone who wants a shot gets one and we don't need to have measures in place to protect them.

It's no one's fault delta is reversing our gains, this is the game we are forced to play.

[Tim]

The answers were known a long time ago:
•treatments
•vaccines

The problem has been a failure to establish metrics or measurements.
•Testing and contact tracing- is intentionally being disregarded.
• Break through statistics- eliminated by CDC
• vaccinated hospitalization .003%
• vaccinated deaths .001%
• Israel - Booster for those over 60.
”Most studies — and real-world data from Britain and the U.S. — so far show that the Pfizer vaccine remains powerfully protective against serious illness. Just Wednesday, Pfizer released data from its long-running 44,000-person study showing that while protection against any symptomatic infection declined slightly six months after immunization, protection against severe COVID-19 remained at nearly 97%. Earlier this month, Israel’s Health Ministry announced that protection against severe disease was around 93%”
• CDC should change course. This is a chronic disease. It is sarcastic but should donuts be prohibited from being sold to obese unvaccinated folks? Hospitalization is .003% and deaths is .001% for vaccinated, not good enough? What is? I could give a crap about chicken pox, irrelevant.
• Accountability for failure to take vaccine? Just who had that in their job description? It certainly was not the vaccinated people. CDC leadership has become a political swamp. Not using tools, metrics or measurable goals.
Set goals, measure them and perform. Quit deflecting and masking (ineffectively at that).
The answers have not changed. Treatments and vaccinations, pretty simple targets. Keep it simple. stupid.
Boosters are not needed for all segments. Get back to the prioritizing. Measure it and find the cost/benefit point. Is .003% good enough?
Consider the “donut rule”. That would reduce the a lot of problems. Vaccinated people are not responsible for changing the goals or lack of credibility for vaccinations. Stupid regulating of those with “good behavior” won’t solve a chronic health problem.

[snowcanyon]

fauci has been tainted from the past missteps.

Chief of public health and epidemiology from Hopkins, mayo or Harvard come to mind. Designate them to review, agree on statements and them rotate on presenting information. That'll keep check and balances and common agreed talking points and policy thoughts that CDC can rely open and then make policy citing them. Relative KIS and arm's length of politics

I agree, but do you think people would listen? Jerome Adams has been consistent with his messaging; people won't listen to him.

[StarTrekDoc]

I agree, but do you think people would listen? Jerome Adams has been consistent with his messaging; people won't listen to him.

I have to believe that a super majority of America will listen to a consensus committee of chiefs of top universities. Heck, get the wildcats and crimson tide chiefs in there to boot and give them the microphone and pulpit.

To date haven't seen that happen.

[G]

I have to believe that a super majority of America will listen to a consensus committee of chiefs of top universities.

STD, that made me chuckle, my internet friend.

[Brains428]

I believe I've read 10 of the 316 pages of this thread, so maybe this has been brought up.

I think people don't understand their own health status. We've all taken histories of "do you have any medical problems" "no" "then what are these medications x, y, and z." But in a broader sense, people who just have obesity as their main health condition probably don't see it as a health condition, and may not even realize they're obese. So overall, people don't understand their own potential risk status (mainly mid 20 to mid 40 year old overweight to obese Americans) for severe disease, and may not get vaccinated because "the young don't usually die of this."

Sorry if this makes no sense. Just trying to type this out between COVID radiographs. Luckily, I've got a macro now.